Diagnostic Difficulties in Bone Sarcoidosis Imaging. A Cases Study

Sarcoidosis is a multiorgan inflammatory disease that rarely involves the musculoskeletal system. A typical radiographic presentation is only noted with phalangeal lesions in the hands and feet, and other skeletal sites of sarcoidosis are a diagnostic imaging challenge [1]. We describe two cases of patients with sarcoidosis in whom pathologic bone marrow lesions were diagnosed on MRI scans. The magnetic resonance findings were non-specific and metastatic lesions or multiple myeloma were suspected. The case analysis serves to point to limitations of imaging studies in diagnosing bone sarcoidosis and underline the importance of cooperation between the radiologist and the clinician. The role of magnetic resonance imaging in the diagnostic algorithm for bone sarcoidosis should mostly focus on locating lesions, indicating biopsy sites and follow-up of abnormalities.

[Exogenous lipid pneumonia--a report of four cases]

Exogenous lipoid pneumonia (ELP) is a rare interstitial pulmonary disease caused by aspiration of the oily material. It is known to mimic many pulmonary diseases and causes many diagnostic difficulties. We present four patients with ELP. The clinical picture was very heterogenous. We described these cases to show that the use of the mineral oils may increase the risk of lipoid pnemonia.

Cellular components of the bronchoalveolar lavage correlate with lung function impairment and extrapulmonary involvement markers in active sarcoidosis

Sarcoidosis is a chronic inflammatory multiorgan disease of unknown origin. Our previous study demonstrated a significant correlation between the relative count of non CD4(+), non CD8(+) lymphocytes in bronchoalveolar lavage of active sarcoidosis patients and proangiogenic activity of BAL homogenates. The aim of the present study was to evaluate in a group of 40 patients with active sarcoidosis the possible relationship between the intensity of alveolitis, particularly the non CD4(+), non CD8(+) lymphocyte subset, and other parameters characterizing the level of pulmonary (lung function tests) and extrapulmonary (spleen longitudinal dimension) disease activity. We found that the relative count of non CD4(+), non CD8(+) lymphocytes in BAL correlated positively with spleen size (r=0.50, P<0.01) and negatively with static compliance (r=0.43, P<0.05). We concluded that the lymphocytes belonging to the non CD4(+)non CD8(+) subset participate in the inflammatory process in sarcoidosis. However, more detailed phenotypic and functional characteristics of this cellular population are needed.

[Prognostic value of some clinical, radiological, laboratory and functional parameters in sarcoidosis]

Sarcoidosis is a granulomatous disease of unknown origin characterized by the trend to spontaneous remission in the great number of the patients. Some patients require treatment with corticosteroids, which have significant toxicity. The aim of this study was to assess the prognostic role of many different parameters in the patients with sarcoidosis. 162 sarcoidosis patients were introduced to prospective study: 22 patients were treated because of deterioration in lung function or serious ocular disease and 140 were observed without therapy for two years. We assessed the age, sex, symptoms, serum activity of angiotensin converting enzyme (SACE), hypercalcaemia, hypercalciuria, splenomegaly and HRCT findings at the time of diagnosis. We analyzed the frequency of spontaneous remission of sarcoidosis in the untreated patients. We investigated correlation between these parameters and remission. Statistical comparisons were made with chi-square test. We also applied the k nearest neighbor (k-NN) rule and the leave one out method adopted from the statistical pattern recognition theory. From many different parameters only acute symptoms (erythema nodosum, fever, arthritis) and serum activity of ACE might be helpful in predicting prognosis in the patients with stage I of disease. The patient's age at onset less than 36 years, the appearance of erythema nodosum and ground-glass opacities on HRCT scans portend an excellent prognosis in the patients with stage II of disease.

[Atypical radiologic image of pulmonary sarcoidosis as a diagnostic problem]

Sarcoidosis is a multisystem disorder of unknown cause frequently presenting with hilar lymphadenopathy, pulmonary infiltration, ocular and skin lesions. Multiple circular or oval pulmonary dentisties appear in the less than 5% of patients. We describe 4 sarcoidosis cases with multiple or single tumor lesion. These patients were referred to our department with initial diagnosis of metastatic or primary lung malignancy. Two of them presented the picture of multiple tumors and two had single peripheral lung mass with hilar lymphadenopathy. This report shows difficulties in the diagnosis of the interstitial lung diseases when the radiological pattern mimics malignancy.

[Evaluation of angiogenic activity in sera from patients with interstitial lung diseases]

Angiogenesis is a process of new blood vessels' formation occurring in many physiological and pathological conditions. Neovascularisation is the principal vascular response in chronic inflammation and concomitant fibrotic process. Microvascular changes in various organ sites in sarcoidosis (BBS) and some of the symptoms of the disease may be related to microangiopathy. Moreover, vascular alterations were also observed in lung specimens from idiopathic pulmonary fibrosis (IPF) and avian fanciers lung (AFL) patients. The present study was aimed at testing the effects of serum from 43 patients with ILD (24 BBS, 8 AFL, 8 IPF, 3 DIPF--drug induced pulmonary fibrosis) and 11 healthy controls on angiogenic capability of normal blood peripheral mononuclear cells (PBMC) in the murine intradermal angiogenesis assay (according to Sidky and Auerbach). The data demonstrated that sera from ILD patients significantly enhanced angiogenic capacity of normal PBMC as compared to control sera (p < 0.001). The effect was more pronounced for AFL patients than for BBS and IPF ones (p < 0.05). Sera from DIPF did not stimulate angiogenesis compared to control sera. The data showed that sera from ILD patients constitute sources of mediators participating in angiogenesis. This phenomenon may play role in pathogenesis of chronic immunological processes in lung.

[Lung and pleural changes caused by exposure to asbestos]

Asbestos exposure results in an increased risk of nonmalignant as well as of malignant pulmonary and pleural disease. The asbestos-related disease are inexorably progressive (cancer) or insidious (fibrosis), untreatable and widespread in the industrialized and urban world. The identification of these diseases is important because therapy and prognosis differ from the other pulmonary fibrosis. The case reports indicate that careful clinical and histologic examination allows proper diagnosis. Two patients with asbestos-related disease after asbestos exposure are described.

[Evaluation of respiratory muscle strength in patients with interstitial lung changes based on simultaneous measurement of esophageal and mouth pressure]

A well know good relation between nasal and oesophageal inspiratory pressures exists in healthy and in COPD patients "sniff manoeuvres. Similar results are obtained using "gasp" maneuvers. The aim of the study was to appreciate the usefulness of "gasp" for evaluation of inspiratory muscles strength in ILD patients. 18 ILD patients were examined: group A consisted of 9 pts (8M+IF) aged 35 +/- 8.6 yrs, with static compliance > 70% pred. (mean 98.6 +/- 16.3), group B consisted of 9 pts (6M + 3F) (aged 52 +/- 13.0) with static compliance < 70% pred. (mean 37.2 +/- 12.0), Pmo and Poe (Milic-Emili method) were measured simultaneously during breathing with Pflex device (1.7 mm diameter). Results were stored in a computer for further analysis. In all patients spirometry, plethysmography and maximal inspiratory (MIP) and maximal expiratory (MEP) pressure measurements were performed. Poe and Pmo in group A were nearly the same (8.16 +/- 1.82 vs. 8.35 +/- 2.74 kPa), but in the group B Pmo was lower than Poe (4.81 +/- 1.59 vs. 6.19 +/- 2.03 kPa; p < 0.0005). We conclude that "gasp" - Pmo is a useful method for inspiratory muscle strength measurement only in ILD patients with normal static compliance but in ILD patients with decreased compliance "gasp" - Poe measurement in necessary.

[Tuberculosis of the bones and joints]

The incidence of tuberculosis has increased over the last several years. Bones and joints tuberculosis makes 20% of all extrapulmonary locations of tuberculosis. In Poland this form of tuberculosis is underdiagnosed. We present three cases with tuberculosis of bones, joints and lung to remind the basic principles of diagnosis and treatment.